Symmetric Bilateral Caudate, Hippocampal, Cerebellar, and Subcortical White Matter Mri Abnormalities in an Adult Patient with Heat Stroke

Reversible Focal Cerebral Cortical Lesions in a Patient with Heat Stroke

“…Microthrombosis can result in small vessel ischemic damage, and heat itself can be directly cytotoxic. Brain damage can be transient or eventually result in irreversible injury (1,4). Transient hyperintense signals in the right temporoparietooccipital cortex on DWI in our patient suggest the presence of transient cortical injury that may have been caused by vasogenic edema.…”

“…The cerebellum is most susceptible to lesion formation in patients with heat stroke. Previous case studies using MRI have shown lesions or atrophy of the cerebellum as well as cerebellar symptoms such as limb ataxia (2)(3)(4)(5)(6)(7)(8). Such findings are explained by the selective vulnerability of Purkinje cells to heat-induced injury (3).…”

“…These findings may have been associated with DIC, which was observed in our patient on admission. DIC can cause microthrombosis and results in small vessel ischemic damage (1,4).…”

“…Heat stroke is often fatal, and those who do survive may sustain permanent neurologic damage (1). The brain is one of the organs that is most vulnerable to heat stroke, and brain lesions caused by heat stroke are bilateral and symmetrical in most cases (2)(3)(4)(5)(6)(7)(8). We herein report the first case of a patient with heat stroke presenting with focal reversible cortical lesions demonstrated on diffusion-weighted magnetic resonance imaging (MRI).…”

Improved Detection of Heat Stroke-Induced Brain Injury by High B-Value Diffusion-Weighted Imaging

“…Central nervous system (CNS) is extremely vulnerable to injury by heat stroke, and is virtually involved in all cases (3)(4)(5)(6). Injury to CNS is considered to be caused by several mechanisms: direct toxicity by heat to certain cell types which contain abundant concentration of heat shock proteins (e.g., Purkinje cells of cerebellum), small vessel ischemia secondary to altered hemostasis (sepsis-like phenomenon), inflammation and apoptosis triggered by interleukin-1 release, and ischemia induced by prolonged vasogenic edema which results from cytokine-induced leakiness of blood-brain or blood-cerebrospinal fluid barrier (6)(7)(8)(9)(10). Cerebellum, basal ganglia, hypothalamus and limbic system are known to be highly vulnerable to heat stroke-induced brain injury (3,6).…”